Hillary Clinton has had three episodes of venous thromboses (clots in veins): deep vein thromboses in her leg in 1998 and 2009 and thromboses in veins in her brain (cerebral venous thromboses) in 2012. On July 31, 2015, Ms. Clinton’s doctor revealed that Ms. Clinton still takes the blood thinner (anticoagulant drug) Coumadin (warfarin). If her doctors follow current clinical practice guidelines, Coumadin or other blood thinners will continue for the rest of her life. This puts her at high risk for major bleeding.
In peer-reviewed articles in the medical literature like the Cochrane Database of Systematic Reviews and Stroke (a journal of the American Heart Association/American Stroke Association), I assessed the long-term risks of patients with these types of previous venous thrombosis of having future venous thrombosis recurrences and of having major bleeding from anticoagulation treatment. I calculated the cumulative risk of venous thromboembolism and cerebral venous thrombosis recurrences, and the likelihood of surviving a venous thrombosis recurrence without anticoagulation. I also evaluated the risk of anticoagulant-related major bleeding from August 2015 until January 2025 (the end of a second U.S. Presidential term should she win election in 2016 and re-election in 2020).
My findings challenge medical orthodoxy.
Clinical practice guidelines mandating anticoagulant treatment for venous thromboembolism and cerebral venous thrombosis are not evidence-based to reduce the chance of dying of a person with venous thrombosis. The anticoagulants typically prescribed are heparin (unfractionated heparin or low-molecular-weight heparin) and oral anticoagulants like Coumadin (warfarin), as with Ms. Clinton’s case, or newer anticoagulants like Pradaxa (dabigatran), ribaroxaban (Xarelto), apixaban (Eliquis), and Edoxaban (Savaysa).
Given Ms. Clinton’s previous venous thromboses, she has about 5 times the chance of a women her age of developing another venous thrombosis. However, this amounts to only about a 20% chance of another venous thrombosis over the next 10 years. If she remains otherwise healthy (i.e., no advanced cancer, heart failure, etc.) and yet she does develop a future venous thrombosis, her chance of dying of the thrombosis without anticoagulation treatment would be only about 1.5%.
Some good news is that medical literature studies suggest that she might reduce the risk of developing future venous thromboses with low thrombosis risk diets—Mediterranean, vegetarian, or vegan.
As I have detailed in a blog for healthcare professionals and evidence-based medicine experts, by continuing guidelines-compliant lifetime anticoagulation treatment, the chance of a major bleed before January 2025 would be about 50%. This includes about a 10% chance of a fatal or disabling hemorrhage.
I have petitioned the Food and Drug Administration to withdraw their approval of anticoagulant drugs for venous thromboses and to make the use of anticoagulants for venous thrombosis contraindicated (banned). My petition is under consideration.
Leaders of the Food and Drug Administration, National Institutes of Health, American College of Chest Physicians, and American Heart Association/American Stroke Association are all responsible for venous thromboembolism and cerebral venous thrombosis guidelines requiring anticoagulation treatment. They need to be held accountable. Ms. Clinton’s life and health and that of hundreds of thousands of other Americans is in jeopardy because of Coumadin, an unnecessary and dangerous drug with her condition.
dkcundiff
It’s good to see our qualitative suspicions corroborated by evidence-based quantitative estimates. Thank you for posting this. I can only hope it will come to the attention of Ms Clinton – and of other VTE sufferers.
You collaborated briefly with my old friend and colleague Paul Agutter, through whom I obtained the link to this site; he passed on your e-mail alerting us to your new blog. Unfortunately his state of health now precludes most activities, physical or mental, but I know he continues to support your position. As for me, I’m no longer a medical practitioner; I’ve turned to writing fiction and collecting traditional folktales; but I remain interested in work such as yours, and I admire your determined stance in the face of official intransigence.
While there’s epidemiological support for your diet-based approach to prophylaxis, we’d need to see a lot more evidence before its efficacy could be assessed critically. Paul and others have argued for a more rationally-based approach to mechanical prophylaxis, believing current methods to be based on a misunderstanding of the aetiology of DVT. I’d be interested to know your views on their position.